protocol for a living systematic review

Funding Information: This study was funded by the Solidarity Fund, through a grant administered by the World Health Organization. Publisher Copyright: ©Ana Paula Cavalcante de Oliveira, Mariana Lopes Galante, Leila Senna Maia, Isabel Craveiro, Alessandra Pereira da Silva, Ines Fronteira, Raphael Chança, Paulo Ferrinho, Mario Dal Poz.Background: Countries and health systems have had to make challenging resource allocation and capacity-building decisions to promote proper patient care and ensure health and care workers’ safety and well-being, so that they can effectively address the present COVID-19 pandemic as well as upcoming public health problems and natural catastrophes. As innovations are already in place and updated evidence is published daily, more information is required to inform the development and implementation of policies and interventions to improve health and care workforce capacity to address the COVID-19 pandemic response. Objective: The objective of this protocol review is to identify countries’ range of experiences with policies and management interventions that can improve health and care workers’ capacity to address the COVID-19 pandemic response and synthesize evidence on the effectiveness of the interventions. Methods: We will conduct a living systematic review of quantitative, qualitative, and mixed methods studies and gray literature (technical and political documents) published in English, French, Hindi, Portuguese, Italian, and Spanish between January 1, 2000, and March 1, 2022. The databases to be searched are MEDLINE (PubMed), Embase, SCOPUS, and Latin American and Caribbean Health Sciences Literature. In addition, the World Health Organization’s COVID-19 Research Database and the websites of international organizations (International Labour Organization, Economic Co-operation and Development, and The Health System Response Monitor) will be searched for unpublished studies and gray literature. Data will be extracted from the selected documents using an electronic form adapted from the Joanna Briggs Institute quantitative and qualitative tools for data extraction. A convergent integrated approach to synthesis and integration will be used. The risk of bias will be assessed with Joanna Briggs Institute critical appraisal tools, and the certainty of the evidence in the presented outcomes will be assessed with the Grading of Recommendations, Assessment, Development and Evaluation. Results: The database and gray literature search retrieved 3378 documents. Data are being analyzed by 2 independent reviewers. The study is expected to be published by the end of 2023 in a peer-reviewed journal. Conclusions: This review will allow us to identify and describe the policies and strategies implemented by countries and their effectiveness, as well as identify gaps in the evidence.publishersversionpublishe

The Brazilian Oral Health National Politics: an analysis on the re-organization of oral care in Rio de Janeiro State in face of federal incentives

Esta dissertação foca o processo de reorganização das ações e serviços de saúde bucal no estado do Rio de Janeiro. Este processo, em tese, deve ser orientado pelas diretrizes da Política Nacional de Saúde Bucal (PNSB) que priorizam a atenção básica em saúde bucal através da Estratégia Saúde da Família e ampliam a atenção em saúde bucal na média e alta complexidades. O Ministério da Saúde lança mão de incentivos financeiros para induzir, sob condições específicas, a adesão às diretrizes formuladas pela Política Nacional de Saúde Bucal (PNSB) e assim promover um processo de reorganização da atenção à saúde bucal nas esferas subnacionais. O núcleo deste trabalho tem por base uma pesquisa que analisa um amplo espectro de dados sobre os serviços e as ações de saúde bucal realizadas pelo conjunto dos municípios do estado do Rio de Janeiro no período de janeiro de 1998 a dezembro de 2007. As principais conclusões da pesquisa apontam para o caráter inconcluso do processo de reorganização da atenção em saúde bucal na grande maioria dos municípios estudados e para a necessidade de uma ação conjunta entre as autoridades sanitárias das esferas federal, estadual e municipal orientada para promover uma efetiva melhoria das condições de saúde da população tal como é a proposta da PNSB.This thesis focuses the process of reorganization of the oral care services in Rio de Janeiro State, Brazil. This process is supposed to follow the so called Política Nacional de Saúde Bucal [Brazilian Oral Health National Politics], whose main proposals are to prioritize primary care as part of the Family Health Strategy and to improve secondary care in oral health services in all levels of complexity. The Health Ministry uses financial incentives to stimulate local governments to adopt, under specific conditions, the guidelines to re-organize oral care services. The core of the present thesis is a research on the re-organization of oral care services carried out by the 92 local governments which form Rio de Janeiro State, from January 1998 to December 2007. It analyzes oral health services in all these municipalities. The main conclusions are that re-organization of oral care services following this politics principles and guidelines is an endless process for most of the municipalities being studied. The research also presents, as secondary conclusion, that federal health authorities must act together with other federal, state and local health authorities to improve the populations oral health conditions, as proposed by the Brazilian Oral Health National Politics

The consolidation of the National Oral Health Policy: tertiary care as challenge for the second decade of the Brazilian oral health policy

Esta tese tem por objeto descrever e analisar o processo de desenvolvimento da Política Nacional de Saúde Bucal (PNSB) no terceiro nível de atenção. Para entender esse desenvolvimento, foram realizados três macroprocessos de pesquisa. O primeiro grupo de pesquisas procurou mapear a distribuição espacial dos hospitais com disponibilidade de leitos/SUS nos país e saber, dentre estes, quantos contam com serviços de atenção à saúde bucal cadastrados no Sistema de Cadastro Nacional de Estabelecimentos de Saúde (SCNES). O segundo grupo de pesquisas se ocupou em levantar junto ao DATASUS, através das ferramentas de consulta TABNET e TABWIN, dados nacionais relativos ao movimento das Autorizações de Internação Hospitalar (AIH) voltadas para procedimento de código 041402041-3 cuja descrição é Tratamento Odontológico para Pacientes com Necessidades Especiais em todas as unidades hospitalares que apresentaram este tipo de produção no país no biênio 2011/12. Foram consideradas 15 categorias de análise. O terceiro grupo de pesquisas buscou levantar junto ao site do Ministério da Saúde dados das Comissões Intergestores Regionais (CIR) existentes no Brasil até dezembro de 2012 assim como os Planos Diretores de Regionalização (PDR) e os Planos Estaduais de Saúde (PES) dos 26 estados e do Distrito Federal. Os resultados da pesquisa foram cotejados com aqueles verificados no TABWIN acerca do local de internação e de residência dos usuários SUS que se submeteram ao procedimento pesquisado. A fim de permitir uma análise comparativa deste processo numa perspectiva internacional, também foram levantados dados acerca da assistência hospitalar pública em saúde bucal levada a termo nos três países da América do Norte e em 31 países da Europa. Os resultados das pesquisas revelaram o caráter focalizador da atual ação da PNSB, em contraste com a atenção à saúde bucal hospitalar realizada na grande maioria dos países estudados. Entre outros resultados, as pesquisas permitiram concluir que: somente 32% dos hospitais que apresentaram AIH para os fins pesquisados possuía serviço de atenção à saúde bucal cadastrado SCNES; 1% das AIH apresentadas está relacionado ao atendimento de pacientes internados por motivos médicos; e 44% dos estados brasileiros preveem em seus instrumentos de gestão a atenção à saúde bucal em nível hospitalar. Assim, são apresentadas algumas sugestões tanto para o aperfeiçoamento da normatização da PNSB no que diz respeito à gestão da Rede de Cuidados à Pessoa com Deficiência, como para a expansão e extensão dos cuidados assistenciais em saúde bucal a todos os pacientes internados ou em tratamento ambulatorial nos hospitais do SUS.This thesis aims to describe and analyze the development process of the National Oral Health Policy (PNSB) in the third level of assistance. To understand it, three research processes were performed. The first sought to map the spatial distribution of Brazilian hospitals with available beds in the public sector and check how many were registered for oral health assistance in the National Health Services Registry System (SCNES). The second used statistics tabulation tools (TABNET and TABWIN) from the Ministry of Healths data department (DATASUS) to search for the registration of Hospital Admission Authorization (AIH) with procedure code 041402041-3 (Dental treatment for patients with special needs) in the country in the biennium 2011/12. Fifteen analysis categories were considered. The third examined the Ministry of Healths website for the existing Regional Management Commissions (CIR) in Brazil until December 2012 as well as for the Master Regionalization Plans (PDR) and the State Health Plans (PES) of the 26 Brazilian states and the Federal District. These results were compared to the ones produced by the TABWIN tool regarding hospital and residence venues of the users who have undergone the searched procedure in the Brazilian National Health System (the so-called SUS). In order to allow a comparative analysis of this process in an international perspective, three countries in North America and 31 European countries were surveyed on the oral health care procedures available in their public hospitals. The results revealed the current focalizing character of the PNSB in contrast to the hospital oral health care practiced in most studied countries. Among other results, the research showed that: Only 32% of the hospitals with AIH for the studied procedure have its oral care service registered in the SCNES; 1% of AIH is related to patients hospitalized for medical reasons; and 44% of the Brazilian states provide oral health care in hospitals in their management documents. Thus, some suggestions are presented for both PNSB normalization improvement, regarding the management of the health services network for the care of people with disabilities, and for the expansion and extension of oral health care for all inpatients or outpatients in SUS hospitals

A Reorganização da Atenção à Saúde Bucal frente aos incentivos federais: a experiência fluminense

Abstract This paper is a synthesis of the Master Degree thesis named The Brazilian Oral Health National Politics: an analysis on the re-organization of oral care in Rio de Janeiro State in face of federal incentives . The article focuses the process of reorganization of the oral care services in Rio de Janeiro State, Brazil. This process is supposed to follow the so called Política Nacional de Saúde Bucal [Brazilian Oral Health  National Politics], whose main proposals are to prioritize primary care as part of the Family Health Strategy and to improve secondary care in oral health services in all levels of complexity. The Health Ministry uses financial incentives to stimulate local governments to adopt, under specific conditions, the guidelines to re-organize oral care services. The present paper is concentrated on the pioneer research done by the above mentioned about the re-organization of oral care services carried out by the 92 local governments which form Rio de Janeiro State, from January 1998 to December 2007. It analyzes oral health services in all these municipalities. The main conclusions are that re-organization of oral care services following this politics’ principles and guidelines is an endless process for most of the municipalities being studied. The research also presents, as secondary conclusion that federal health authorities must act together with other federal, state and local health authorities to improve the population’s oral health conditions, as proposed by the Brazilian Oral Health National Politics. Key words:  Brazilian Oral Health National Politics; Rio de Janeiro State; financial incentives; Oral Health; financing of Unified Health System.Resumo:Este artigo, que sintetiza os elementos essenciais da dissertação de mestrado intitulada Política Nacional de Saúde Bucal: uma Análise da Reorganização da Atenção à Saúde Bucal no Estado do Rio de Janeiro frente aos incentivos federais, foca o processo de reorganização das ações e serviços de saúde bucal no estado do Rio de Janeiro. Este processo, em tese, deve ser orientado pelas diretrizes da Política Nacional de Saúde Bucal (PNSB) que priorizam a atenção básica através da Estratégia Saúde da Família e ampliam a atenção em saúde bucal na média e alta complexidades. Neste contexto, o Ministério da Saúde lança mão de incentivos financeiros para induzir, sob condições específicas, a adesão às diretrizes formuladas pela PNSB e, deste modo, promover um processo de reorganização da atenção à saúde bucal nas esferas subnacionais.   O presente artigo concentrou-se na pesquisa pioneira contida na referida dissertação que analisou um amplo espectro de dados sobre os serviços e as ações de saúde bucal realizadas pelo conjunto dos municípios do estado do Rio de Janeiro no período de janeiro de 1998 a dezembro de 2007.As principais conclusões da pesquisa apontam para o caráter inconcluso do processo de reorganização da atenção em saúde bucal na grande maioria dos municípios estudados e para a necessidade de uma ação conjunta entre as autoridades sanitárias das esferas federal, estadual e municipal orientada para promover uma efetiva melhoria das condições de saúde da população tal como é a proposta da PNSB. Palavras-chave: Política Nacional de Saúde Bucal; Estado do Rio de Janeiro; Incentivos Federais; Saúde Bucal; financiamento do SUS

Implementation of policy and management interventions to improve health and care workforce capacity to address the COVID-19 pandemic response: a systematic review

Abstract Background The COVID-19 pandemic highlighted pre-existing weaknesses in health and care systems and services and shortages of health and care workers (HCWs). As a result, policymakers needed to adopt measures to improve the health and care workforce (HCWF) capacity. This review aims to identify countries’ range of policies and management interventions implemented to improve HCWs’ capacity to address the COVID-19 pandemic response, synthesize their evidence on effectiveness, and identify gaps in the evidence. Methods The literature was searched in PubMed, Embase, Scopus, LILACS–BVS, WHO’s COVID-19 Research Database and the ILO, OECD and HSRM websites for literature and documents published between January 2020 and March 2022. Eligibility criteria were HCWs as participants and policy and management interventions aiming to improve HCWF capacity to address the COVID-19 pandemic response. Risk of bias was assessed with Joanna Briggs Institute (JBI) Critical Appraisal Tools (CAT) and certainty of the evidence in presented outcomes with GRADE. Results The searches retrieved 3378 documents. A total of 69 were included, but only 8 presented outcomes of interventions implemented. Most of the selected documents described at least one intervention implemented by countries at the organizational environment level to increase the flexibility and capacity of the HCWF to respond to the pandemic, followed by interventions to attract and retain HCWs in safe and decent working environments. There was a lack of studies addressing social protection, human resources for health information systems, and regarding the role of community health workers and other community-based providers. Regarding the risk of bias, most of documents were rated as medium or high quality (JBI’s CAT), while the evidence presented for the outcomes of interventions was classified as mostly low-certainty evidence (GRADE). Conclusions Countries have implemented various interventions, some innovative, in response to the pandemic, and others had their processes started earlier and accelerated by the pandemic. The evidence regarding the impact and efficacy of the strategies used by countries during the pandemic still requires further research